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Early cervical cancer is confined to the cervix and is usually cured by surgery. Recent trials have shown that open surgery is safer than keyhole surgery for radical hysterectomy, that a simple hysterectomy is enough for the smallest tumours, and that young women with small tumours can keep their uterus with a trachelectomy.
FIGO 2018 defines stage IA as microscopic invasion up to five millimetres and stage IB as a visible or deeper tumour confined to the cervix, split into IB1 (up to two centimetres), IB2 (two to four centimetres) and IB3 (over four centimetres, treated as locally advanced). Squamous carcinoma and HPV-associated adenocarcinoma behave similarly at this stage, while HPV-independent gastric-type adenocarcinoma is more aggressive. Diagnosis comes from colposcopic biopsy or an excisional cone after abnormal screening, and MRI and PET-CT stage the tumour and nodes. Stage IA1 without lymphovascular invasion is treated by cone biopsy or simple hysterectomy alone; IA2 to IB2 has traditionally required radical hysterectomy with pelvic lymphadenectomy, followed by chemoradiation when nodes, margins or parametria are involved.
Two trials have reshaped the surgery. LACC randomised women with stage IA1 with lymphovascular invasion to IB1 disease between minimally invasive and open radical hysterectomy and stopped early when disease-free survival at four and a half years was 86.0 percent with keyhole surgery against 96.5 percent with open surgery, and deaths were more frequent; open surgery became the standard again and guidelines reversed a decade of practice. SHAPE then asked the opposite question for the lowest-risk tumours: in stage IA2 to IB1 disease up to two centimetres with limited stromal invasion, simple hysterectomy was non-inferior to radical hysterectomy for pelvic recurrence and caused far fewer urinary and sexual complications, so simple hysterectomy is now an accepted option for these women. Sentinel node biopsy, validated for detection in SENTICOL I and II, is being tested against full lymphadenectomy in SENTICOL III.
Fertility-sparing surgery follows the same logic. Cone biopsy or simple trachelectomy suffices for IA1 and selected IA2 tumours, and radical vaginal or abdominal trachelectomy with node assessment preserves the uterus in IB1 tumours up to two centimetres, with recurrence rates comparable to hysterectomy and live births in a majority of women who try to conceive, though preterm delivery is common. Neoadjuvant chemotherapy to shrink tumours of two to four centimetres before trachelectomy is investigational. HPV vaccination and HPV-based screening are shrinking this whole group of patients, which is the ultimate aim.
In screened populations about half of cervical cancers are found at stage I, often in women in their thirties and forties who have not completed their families; cure rates exceed ninety percent, so the questions are how little surgery is safe and how to preserve fertility.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Cervical cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
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Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cone biopsy with clear margins or simple hysterectomy; no node assessment needed.
Simple hysterectomy with node assessment (SHAPE) or open radical hysterectomy; sentinel node biopsy where a trial or protocol supports it.
Open radical hysterectomy with pelvic lymphadenectomy; minimally invasive radical hysterectomy avoided after LACC.
Cone or simple trachelectomy for IA disease; radical trachelectomy with node assessment for IB1 tumours up to 2 cm.
Pelvic radiotherapy for intermediate-risk features; cisplatin chemoradiation for positive nodes, margins or parametria.
HPV vaccination and HPV-based screening with colposcopy for positives.
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Women with low-risk early cervical cancer can be offered simple hysterectomy, sparing them the bladder and sexual morbidity of parametrectomy, provided strict eligibility criteria are applied.
Open radical hysterectomy is again the standard for early cervical cancer; minimally invasive approaches are used only within protocols that avoid tumour spillage, and the trial is a lesson in adopting surgical innovation without randomised evidence.
Query for this cancer: (TITLE:"Early cervical cancer and fertility-sparing surgery" OR ABSTRACT:"Early cervical cancer and fertility-sparing surgery" OR TITLE:"Stage IA to IB2 cervical cancer" OR ABSTRACT:"Stage IA to IB2 cervical cancer" OR TITLE:"Early-stage cervical cancer" OR ABSTRACT:"Early-stage cervical cancer" OR TITLE:"Fertility-sparing cervical cancer surgery" OR ABSTRACT:"Fertility-sparing cervical cancer surgery" OR TITLE:"Radical trachelectomy candidates" OR ABSTRACT:"Radical trachelectomy candidates") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Early cervical cancer and fertility-sparing surgery, not a curated reading list.
No targets or pathways are linked to this cancer yet. Browse the gene hub →
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
The leukaemia risk after chemotherapy was described in the era of mustards and etoposide, and it did not stay there. Platinum drugs carry it, PARP inhibitors raise it about two and a half times against placebo, and lenalidomide with oral melphalan raises it nearly fivefold against melphalan alone. The absolute numbers are small, but the choice of partner drug is sometimes a real decision.
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